The higher the percentage of residents in a state who say they can't afford health care, the greater the prevalence of serious depression and the higher the suicide rate in that state, suggests a report released to USA TODAY.

The report doesn't prove that lack of care causes depression or suicide, says senior author Tami Mark of Thomson Healthcare. "But it suggests we should be monitoring mental health care and comparing outcomes," she says.

Mark used federal data on mental health and state databases to develop a "depression index," ranking states and the District of Columbia on seriousness and prevalence of depression, as well as suicide rates.

The problem with this “correlation” is that—generally speaking—those who have not got health insurance often have hosts of other issues that lead to their mental illness—joblessness, lack of a social network, poor health, and so on and so on. Correlation does not imply causality.

No Nate, it’s actually quite easy to correlate things—just very difficult to prove causality from those correlations. One might, for instance, be able to correlate hair color to suicide . . . and such a correlation would be insignificant most likely in regards to causality.

One would have to do much more research to come up with the causality of the higher rate of suicide for the uninsured . . . and I very much doubt that the causality for that suicide would be “I was uninsured.”

I wonder if there is any correlation between poverty and depression/suicide? How about a correlation between other mental illness and depression/suicide. We need to remember that the current method of funding health insurance is a direct result of government imposing wage restrictions on corporations during WWII. Before that, health insurance was purchased privately (if at all) and generally consisted of what we would today call “catostrophic” coverage or coverage of finanically significant events (such as a major illness or hospitilization lasting for more than a few days).
So, we will find the unemployed more without health insurance than the employed. We will find those with mental illnesses more unemployed than those without mental illnesses. We will find those depressed more unemployed than those who are not depressed. We will find hopelessness more among drug users than not and more among those in prison than not. The question is not correlation, but causation. Which came first - the depression or the lack of health insurance? Is there a causal relationship between lack of health insurance and depression? If so, what are the other factors (such as unemployement)?

Re: the question of causality between depression and being uninsured or underinsured, I’d say the answer is “Yes.” As someone diagnosed with bipolar disorder, I know a thing or two about depression, and I also know a bit about medical insurance. Basically, even though I’ve been pretty stable for some time now and luckily have never had any hospitalizations because of this, not many insurance plans will want to cover me, especially if I have to buy it as an individual. Even those that will cover me will charge an outrageous sum for it and probably won’t even cover mental health. The only way I can get adequate coverage is through a group plan, which is definitely an incentive for me to stay in school as long as I can. Of course, that brings up the whole debt issue, but I’m sure I’ll die before I have to pay off everything. (Half-joking there)

Depression certainly contributes to not being adequately insured (if I weren’t in school), and the desperation and panic associated with the possibility of being uninsured doesn’t exactly help the depression. Essentially, it’s a vicious circle. Of course, I’m a lucky one in all of this, but I can still see how others can get to the point where the only possibility seems to be to end it all. “There but for the grace of God go I.” If anything has caused me to rely on God, this is it.

“Depression certainly contributes to not being adequately insured (if I weren’t in school), and the desperation and panic associated with the possibility of being uninsured doesn’t exactly help the depression. Essentially, it’s a vicious circle. Of course, I’m a lucky one in all of this, but I can still see how others can get to the point where the only possibility seems to be to end it all. “There but for the grace of God go I.” If anything has caused me to rely on God, this is it. “

AMEN!!! Speaking from personal experience and that of others in my support group, it’s bad enough to have a serious, life-threatening disease and all of the life changes that go with it, but most people (especially people of faith) can adjust. As long as there’s health care, there’s hope (for an improvement, remission, better drug therapy, a cure, etc.) But if you don’t have health coverage and, thus, no access to appropriate care, the hope you’ve been clinging to dissipates.

When my COBRA coverage ended in July, I hunkered down and went into survival mode. I thought (deludedly) that I could keep my condition stable through a veggie-rich diet, supplements, plenty of rest and prayer. Knowing what was coming, I had cut my medication doses on my own so I could stockpile meds and take partial doses for a few extra months. Well, it didn’t work and I got severely depressed until I saw an ad in the Lupus Foundation magazine for a clinical trial for a potential new Lupus drug. I immediately went to the website, did the screening and signed up.

I don’t know if the drug will work, or even if I’ll get the drug instead of the placebo. But the hope is back, and I’ll get medical care by participating in the study. When you have lost your livelihood, your savings, and your home, it’s difficult and humbling but you adjust. But when you lose your physical well-being to a serious illness, you keep your sanity by hoping you may improve someday. Losing medical care extinguishes that hope and leaves one depressed, fearful and hopeless.

I got in to see my rheumatologist a few weeks ago, promising to pay for the visit over time. My condition is poor—he called it “life-threatening”—and he demanded to know why I haven’t been in for my labs and medications. He knows I no longer have insurance. What I wanted to know, and no one would explain, is why his office accepted the $90 my insurance previously paid him for my visits but I have to privately pay $200 for the same visit? Is that just?

Navigate this system with a serious disease and no insurance, and y’all won’t be speculating about other factors regarding depression in the uninsured.

I suppose there is no way to absolutely decide what causes suicide. But sickness is expensive. The system we live in implies that sick people aren’t worth it. I’m sure some people are calculating that suicide is cheaper than people living through emergency room visits.

“I got in to see my rheumatologist a few weeks ago, promising to pay for the visit over time. My condition is poor—he called it “life-threatening”—and he demanded to know why I haven’t been in for my labs and medications. He knows I no longer have insurance. What I wanted to know, and no one would explain, is why his office accepted the $90 my insurance previously paid him for my visits but I have to privately pay $200 for the same visit? Is that just?”

Because of medicaid/medicare rules. The government gets an official discount of your lowest “usual and customary” charge. (Other insurers also get discounts, though not as low as Medicaid. Medicaid doesn’t pay overhead, but most docs see some as “charity”. If you give the uninsured charity, either by writing off the charge completely, or giving them Medicaid rates, then the write off suddenly becomes your “usual and customary charge”. The discounts that the well insured receive become discounted from whatever you charged the uninsured.

For this reason, I am forced to bill the uninsured my “standard charge”. To do otherwise, is considered “insurance fraud”.

If I wish to see the uninsured and not bill them, then I cannot see them in clinic. I need to see them unofficially in places like free clinics (not possible currently as they are not open on weekends or evenings when I am available) or in church.